Evaluation of the enhanced recovery after surgery protocol in living liver donors

Khalil, Ahmed; Ganesh, Swaytha; Hughes, Christopher; Tevar, Amit D.; Hasche, John J.; Esper, Stephen A.; Humar, Abhinav

doi:10.1111/ctr.13342

Cited by 21 publications

(67 citation statements)

References 7 publications

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“…First, our institution implements a robust perioperative pain management program that incorporates an ERAS protocol, which emphasizes multimodal analgesia. This protocol effectively controls pain and promotes early recovery in many surgical patients, including those undergoing urologic procedures 9,16,17 . Our institution's ERAS protocol includes encouraging regular activity and good nutrition preoperatively, clear liquids up to 3 hours before surgery, and gabapentin and acetaminophen in the preoperative holding area.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we had previously demonstrated that the quantity of opioids patients consumed after these surgeries was significantly less than the quantity used 8 . Third, the majority of patients undergoing these surgeries participated in a specific ERAS protocol aimed at minimizing the use of perioperative opioids, among other things 9 . Prostatectomies included those performed through a traditional open approach (with a lower midline incision) or a minimally invasive approach (robotically).…”

Section: Methodsmentioning

confidence: 99%

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Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Jacobs

Rogers

Yabes

et al. 2020

Cancer

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BackgroundSurgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear.MethodsThis was a single‐institution, single‐arm, pre‐ and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre‐intervention phase, an intervention phase, and a washout phase.ResultsThree hundred eighty‐two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all).ConclusionsImplementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient‐reported outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Jacobs

Rogers

Yabes

et al. 2020

Cancer

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“…(ERAS) to achieve early extubation, early functional exercise, and a shortened length of stay at the hospital 33 .…”

Section: Discussionmentioning

confidence: 99%

Application of Various Surgical Techniques in Orthotopic Liver Transplantation: a 10-year Experience at a Single Center

Chen¹,

Han²,

Wang³

et al. 2020

Preprint

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BackgroundLiver transplantation (LT) is considered the only curative treatment for end-stage liver disease (ESLD), and the surgical techniques of LT have continually evolved and have been modified. In this study, we prospectively analyzed a single-center case series in our center and compared the advantages and disadvantages of each method.MethodsIn total, 1,029 patients with OLT at our department were enrolled in this study. The recipient perioperative data were assessed and analyzed. Three types of LT techniques were utilized: modified classic, modified piggy-back (MPB) and classic piggy-back (PB) orthotopic LT, corresponding to groups A, B and C.ResultsCirrhosis was the most prevalent condition in group B, while tumors tended to be more common in group A. Patients in group C were in poorer general condition with higher creatinine, total bilirubin and PT-INR (P = 0.029, 0.011 and 0.026, respectively). Two hundred ninety-five patients had previous abdominal surgery, and the proportion was higher in group B (P = 0.017). The cold ischemia time in group B was longer than those in the other two groups (P<0.001). The mortality rate was 7.9% within 30 days and 11.7% within 90 days. Most of the deaths were not technique-related.ConclusionThe advantages and disadvantages are different for these three surgical techniques. A reasonable operation technique should be adopted considering the patient's unique condition to ensure the stability of hemodynamics.

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“…Multimodal analgesic regime minimising opioid use has been shown to enhance recovery 2 30. ITM has become a well-documented component in several ERAS protocols29 31–34 and a protocol for a systematic review of ITM in abdominal and thoracic surgery patients has recently been published 35. Despite the higher rating of NRS at mobilisation during the first few days in the ITM group, the consumption of opioids was nearly three times lower in the same time period compared with the EDA group, and the QoL index did not differ between the groups.…”

Section: Discussionmentioning

confidence: 99%

Effect of intrathecal morphine and epidural analgesia on postoperative recovery after abdominal surgery for gynecologic malignancy: an open-label randomised trial

et al. 2019

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ObjectivesWe aimed to determine whether regional analgesia with intrathecal morphine (ITM) in an enhanced recovery programme (enhanced recovery after surgery [ERAS]) gives a shorter hospital stay with good pain relief and equal health-related quality of life (QoL) to epidural analgesia (EDA) in women after midline laparotomy for proven or assumed gynaecological malignancies.DesignAn open-label, randomised, single-centre study.SettingA tertiary referral Swedish university hospital.ParticipantsEighty women, 18–70 years of age, American Society of Anesthesiologists I and II, admitted consecutively to the department of Obstetrics and Gynaecology.InterventionsThe women were allocated (1:1) to either the standard analgesic method at the clinic (EDA) or the experimental treatment (ITM). An ERAS protocol with standardised perioperative routines and standardised general anaesthesia were applied. The EDA or ITM started immediately preoperatively. The ITM group received morphine, clonidine and bupivacaine intrathecally; the EDA group had an epidural infusion of bupivacaine, adrenalin and fentanyl.Primary and secondary outcome measuresPrimary endpoint was length of hospital stay (LOS). Secondary endpoints were QoL and pain assessments.ResultsLOS was statistically significantly shorter for the ITM group compared with the EDA group (median [IQR]3.3 [1.5–56.3] vs 4.3 [2.2–43.2] days; p=0.01). No differences were observed in pain assessment or QoL. The ITM group used postoperatively the first week significantly less opioids than the EDA group (median (IQR) 20 mg (14–35 mg) vs 81 mg (67–101 mg); p<0.0001). No serious adverse events were attributed to ITM or EDA.ConclusionsCompared with EDA, ITM is simpler to administer and manage, is associated with shorter hospital stay and reduces opioid consumption postoperatively with an equally good QoL. ITM is effective as postoperative analgesia in gynaecological cancer surgery.Trial registration numberNCT02026687; Results.

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Evaluation of the enhanced recovery after surgery protocol in living liver donors

Abstract: Enhanced recovery after surgery protocol was effective in minimizing postoperative pain and helped to decrease the postoperative narcotics and helped early recovery.

Cited by 21 publications

References 7 publications

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Application of Various Surgical Techniques in Orthotopic Liver Transplantation: a 10-year Experience at a Single Center

Effect of intrathecal morphine and epidural analgesia on postoperative recovery after abdominal surgery for gynecologic malignancy: an open-label randomised trial

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